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SEXUAL HEALTH AND HIV > GENITAL ULCER DISEASE > Flashcards

GENITAL ULCER DISEASE Flashcards

1
Q

What is the 3 most common STI causes of genital ulceration?

A

Genital herpes

Primary syphilis

Lymphogranuloma venereum

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2
Q

What are the viruses responsible for genital herpes?

A

Herpes simplex type 1 (HSV-1)

Herpes simplex type 2 (HSV-2)

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3
Q

What is the most common type of transmission of HSV-1 in the UK?

A

Orogenital route in sexual contact

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4
Q

What is the incubation period of herpes simplex viruses?

A

5-14 days

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5
Q

What proportion of people will develop signs or symptoms of HSV infection during the initial acquisition?

A

Less than half

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6
Q

Where do the HSV viruses initial reside and travel to in the body?

A

Enters into the distal axonal processes of the sensory neuron and travels to the sensory (dorsal root) ganglion where it remains dormant.

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7
Q

How does a herpes virus reactivate after a latent stage?

A

Travels back down axons to basal skin layers. Some of these episodes will result in symptoms, others will be asymptomatic. In this way patients may not know they are infected and may therefore pass on virus unaware.

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8
Q

What is the prevalence of HSV-2 infection in the UK?

A

9%

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9
Q

Which type of HSV infection recurs more frequently?

A

Type 2

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10
Q

What groups have higher rates of HSV infection?

A

Sex workers

MSM

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11
Q

How often does HSV-2 typically recur in the first year?

A

4

10% may experience more than 10 episodes per year

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12
Q

How often does HSV-1 typically recur?

A

Once every 18 months

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13
Q

What is the definition of the first episode of genital herpes?

A

This is the first time a person has clinical features of genital herpes

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14
Q

What are the clinical features of genital herpes?

A

Lesions start as vesicles

Then become superficial very painful ulcers

Ulcers may coalesce to form larger superficial lesions

These form the characteristic serpiginous edges

Local tender lymphadenopathy

Muscle aches in lower limbs

Systemic features (reported in 10%) - headache, malaise and photophobia

Fissures

Erythema

Dysuria

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15
Q

How long does a typical first episode of genital herpes last for?

A

3 weeks

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16
Q

What are the local complications of HSV infection?

A

Superinfection of lesions with streptococci and/or staphylococci

Adhesion formation

Vaginal candida infection exacerbation symptoms

External dysuria can lead to urinary retention

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17
Q

What are the distant complications of HSV infection?

A

Myalgia

Dissemination (rare outside of neonates and pregnancy)

Autoinoculation to distant sites

Erythema multiforme

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18
Q

What are the neurological complications of HSV infection?

A

Headaches

Encephalitis

Radiculitis

Transverse myelitis

Autonomic neuropathy

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19
Q

What are the prodromal symptoms of a recurrent episode of HSV?

A

Itch

Tingling

These can be false prodromes where no lesions then occur

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20
Q

What are the triggers of a recurrent episode of HSV?

A

Often nothing

UV irradiation

Localised trauma

21
Q

What is the distribution of a recurrent episode of HSV?

A

Dermatomal

22
Q

What factors increase the chance of experiencing a recurrent episode of HSV?

A

HSV type 2

No previous infection with other HSV type

Male

First year following infection

Symptomatic acquisition episode

Prolonged acquisition episode

Damaged immune system

23
Q

How do we diagnose HSV?

A

PCR - most accurate

Culture

Antigen detection directly from genital lesions

24
Q

Why is viral typing useful as part of diagnosis?

A

Gives some prognostic value

25
Q

How do we treat the first episode of genital herpes?

A

Aciclovir 400 mg TDS or 200 mg 5 times a day (5-10 days)

OR

Valaciclovir 500 mg BD (5-10 days)

OR

Famciclovir 250 mg TDS (5-10 days)

26
Q

How do we treat episodic genital herpes?

A

Aciclovir 800 mg TDS for 2 days or 200 mg 5 times a day for 5 days

OR

Valaciclovir 500 mg BD for 3-5 days

OR

Famciclovir 1 g BD for 1 day or 125 mg BD for 5 days

Should be taken during the prodrome or in the first 24 to 48 hours as a lesion is developing.

27
Q

What treatment do we use for suppressive therapy?

A

Aciclovir 400 mg BD

OR

Valaciclovir 500 mg - 1 g OD

28
Q

What is the threat of HSV in pregnancy?

A

Acquisition of HSV infection in the third trimester of pregnancy is associated with an unacceptable high risk of HSV transmission to the neonate with vaginal delivery. Delivery should therefore be CS.

29
Q

What is lymphogranuloma venereum (LGV)?

A

STI also known as tropical or climatic bulbo, and lymphogranuloma inguinale. It is caused by a type of Chlamydia trachomatis (serovar L). These organisms invade and destroy lymphatic tissue.

30
Q

Where is lymphogranuloma venereum (LGV) particularly prevalent?

A

Tropical countries

31
Q

Is classic LGV usually acquired heterosexually or homosexually across the world? In the UK?

A

World: Heterosexually

UK: homesexually

32
Q

What are the names of the different stages of LGV infection?

A

Primary - transient genital ulceration

Secondary - inguinal or anorectal syndrome

Tertiary - genito-anorectal syndrome

33
Q

How long after infection does the primary stage of LGV occur?

A

3-30 days after infection

34
Q

What are the features of the primary stage of LGV?

A

Transient solitary papule or ulcer at the site of inoculation

Sometimes painful

Heals rapidly without scarring

35
Q

How long after infection does the secondary stage of LGV occur?

A

2-6 weeks

36
Q

What are the features of the secondary stage of LGV?

A

Inguinal syndrome:
Unilateral inguinal and/or femoral lymphadenopathy
Formation of buboes (enlarged tender glands in the groin - they can rupture)
Groove sign

37
Q

What is the ‘groove sign’ in classic LGV?

A

Groove like depression causing by femoral and inguinal lymph node enlargement above and below inguinal ligament.

38
Q

Is inguinal and femoral lymphadenopathy more associated with LGV in men or women?

A

Men - primary involvement in women is usually in the vagina, cervix, posterior urethra or rectum which drain into deeper lymph nodes

39
Q

What are the features of the third stage of LGV infection?

A

Chronic untreated infection which causes fibrosis which leads to lymphatic obstruction and hence genital lymphoedema (elephantiasis).

40
Q

What are the complications associated with tertiary LGV infection?

A

Rectal strictures

Proctitis

Colitis

Perianal abscess

Perineal fistulae

Rectovaginal fistulae

Urethral fistulae

41
Q

How do we diagnose LGV infection?

A

PCR from samples taken from lesions

42
Q

How do we manage LGV infection?

A

Doxycycline 100 mg BD for 3 weeks

OR

Erythromycin 500 mg QDS for 3 weeks

Buboes may require repeated aspiration

43
Q

What is the organism that causes chancroid?

A

Haemophilus ducreyi

44
Q

What is the incubation period of haemophilus ducreyi causing chancroid?

A

3-10 days

45
Q

What are the features of chancroid?

A

Single or multiple anogenital ulcers

Soft ulcers

Sore

Purulent base with contact bleeding

Painful lymphadenopathy

46
Q

What are the complications of chancroid?

A

Phagedenic ulceration - tissue destruction

Inguinal abscess formation (bubo)

Chronic suppurative sinuses

47
Q

How do we diagnose chancroid?

A

Microscopy/culture

PCR - not widely available

48
Q

How do we treat chancroid?

A

Azithromycin 1 g stat

OR

Ceftriaxone 250 mg IM stat

OR

Ciprofloxacin 500 mg BD for 3 days

OR

Erythromycin 500 mg QDS for 7 days

Buboes may require repeated aspiration

SEXUAL HEALTH AND HIV (13 decks)

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